The main causes for testicular or scrotal pain include the following:
- Infection or inflammation—The most common condition related to testicular inflammation and infection is epididymitis (inflammation of one or both epididymes). As the epididymis is attached to the testicle, infection often spreads to the testicle (called epididymo-orchitis). Orchitis is inflammation of the testicle, which only rarely occurs by itself. These conditions, which can occur at any age, may cause severe, sudden pain.
- Trauma or injury—Sports injuries are common causes of testicular trauma. A puncture wound or pain that continues more than one hour after blunt force to the scrotum should be treated as a medical emergency.
Lumps found after an injury may or may not be related to the injury. In fact, tumors are commonly discovered when the testicles are examined after an injury. Especially because testicular cancer is easily treated if found early, any lump should be assessed by a doctor as soon as possible.
- Testicular torsion is a relatively rare, urgent situation in which the spermatic cord twists, blocking blood flow to the testicles. Testicular torsion causes acute (severe) scrotal pain and swelling. It can lead to tissue death that requires removal of the affected testicle(s) if not treated within 5-6 hours. It most commonly occurs in newborns and adolescent males under 18, but can occur at any age.
- Torsion of testicular appendages (e.g., testicular appendix, epididymis appendix) may feel similar to testicular torsion, but involves twisting of unnecessary appendages that are remnants from embryonic development. It is more common in boys who have not yet entered puberty, and is a leading cause of acute scrotal pain in boys.
Proper diagnosis is urgent in order to rule out testicular torsion, but torsion of testicular appendages is not itself an emergency. The pain usually subsides within one week with no complications.
Other causes for pain in the scrotal area include the following:
- Testicular tumors do not usually cause pain, but it is possible. Since testicular cancer is common in young men (between the ages of 18 and 32) and is often cured if treated early, prompt medical attention to any lump is important.
- Inguinal hernia—In an inguinal hernia, part of the intestines protrudes through the inguinal canal (passageway connected to the scrotum). Inguinal hernia is suspected if swelling or pain above the scrotum worsens with coughing, sneezing, movement, or lifting.
This condition is fairly common, especially in young boys, and it occasionally causes pain in the scrotal area. Premature infant boys have the highest risk for inguinal hernia. This condition usually results from an abdominal wall weakness present at birth, but symptoms may not appear until adulthood.
Hernias do not resolve without treatment and may cause serious complications if not treated. Hernia repair surgery is usually required to treat this condition.
- Pudendal nerve damage (neuropathy), also called "bicycle seat neuropathy," may cause numbness or pain. Pudendal nerve damage can result from the pressure of prolonged or excessive bicycle riding (e.g., competitive cycling), especially improper seat position or riding techniques are used. Special bicycle seats have been designed to decrease pressure on the perineum, potentially preventing or resolving this problem.
Pudendal neuralgia is the painful type of this nerve damage. Sometimes called "cyclist's syndrome," pudendal neuralgia is painful inflammation of the pudendal nerve. The pudendal nerve carries sensations to the genitals, urethra, anus, and perineum (area between the scrotum and anus), so the pain can be felt in any of these areas. Pain can be piercing and is more likely to be noticed while sitting.
According to The Society for Pudendal Neuralgia, pudendal neuralgia also may result from structural abnormalities, repetitive stress from sports or chronic constipation, or surgery. If untreated, nerve damage can lead to erectile dysfunction or problems with bowel movements or urination, such as involuntary loss of feces or urine (e.g., urinary incontinence).
- Surgery—Temporary testicular pain and swelling can be expected after surgical procedures in the pelvic area, such as hernia repair and vasectomy. Post-surgery pain that lasts longer than expected should be reported to a physician. Chronic or recurring pain may be the result of a surgical complication or an unrelated problem, and may need treatment.
- Kidney stones—Stones usually cause abdominal pain, but the pain radiates into the testicular area in some cases. Intense, sudden, and severe pain in the scrotum that cannot be explained by a problem in the scrotum may be caused by kidney stones.
- Swelling with mild discomfort—Conditions that cause swelling in the scrotal area also may occasionally result in mild discomfort. These conditions include varicocele, hydrocele, and spermatocele. Many cases are benign (mild and non-threatening), but swelling and discomfort in the scrotal area should be addressed by a doctor. If a hydrocele (an abnormal fluid-filled sac around the testicles) becomes infected, it can lead to epididymitis, which can cause severe pain.
- Unrelieved erection—An erection that does not end in ejaculation sometimes can cause a dull ache in the testicles. This minor ache, commonly called "blue balls," is harmless and usually goes away within a few hours or when ejaculation occurs.